Mind over matter: Patients' perceptions of illness make a difference

In the February issue of Current Directions in Psychological Science, a journal of the Association for Psychological Science, Keith Petrie, of the University of Auckland, and John Weinman, of the Institute of Psychiatry at King's College, review the existing literature on patients' perceptions of illness. The authors find that people's illness perceptions bear a direct relationship to several important health outcomes, including their level of functioning and ability, utilization of health care, adherence to treatment plans laid out by health care professionals, and even overall mortality.

In fact, some research suggests that how a person views his illness may play a bigger role in determining his health outcomes than the actual severity of his disease.

In general, our illness perceptions emerge out of our beliefs about illness and what illness means in the context of our lives. So, we might have beliefs about how an illness is caused, how long it will last, how it will impact us or our family members, and how we can control or cure it. The bottom line, says Petrie, is that "patients' perceptions of their illness guide their decisions about health." If, for example, we feel like a prescribed treatment isn't making us feel better we might stop that treatment.

Research on illness perceptions suggest that effective health care treatment plans are about much more than having a competent physician. According to Petrie, "a doctor can make accurate diagnoses and have excellent treatments but if the therapy doesn't fit with the patient's view of their illness, they are unlikely to keep taking it." A treatment that does not consider the patient's view is likely to fail, he argues.

The authors conclude that understanding illness perceptions and incorporating them into health care is critical to effective treatment. Asking patients about how they view their illness gives physicians the opportunity to identify and correct any inaccurate beliefs patients may have. Once a patient's illness perceptions are clearly laid out, a physician can try to nudge those beliefs in a direction that is more compatible with treatment or better health outcomes. Such conversations can help practitioners identify patients that are at particular risk of coping poorly with the demands of their illness.

Research confirms that brief, straightforward psychoeducational interventions can modify negative illness beliefs and lead to improvements over a range of different health outcomes. But this research is still new and scientists don't know much about how our illness perceptions develop in the first place. With mounting pressure to lower the costs of healthcare, continued research on illness perceptions will help practitioners design effective interventions that are able to reach a large number of patients.